FORESIGHT - gov.uk · The Foresight project on Brain Science, ... Jeyavani Atchuthan from the...

Drugs Futures 2025?

Public Perspectives

FORESIGHT

OFFICE OF SCIENCE AND TECHNOLOGY

While the Office of Science and Technology commissioned this report, the views arethose of the authors, are independent of Government and do not constitutegovernment policy.

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Executive Summary 1

Organisation of report 4

Acknowledgements 5

Objectives 5

Approach and sample 6

Introduction 9

Section I: The Forum 14

Introduction 14

Talking with the public 14

Exploring the trade-offs 16

Section II: Debating the issues 22

Introduction 22

The case studies 22

Context of use 23

Science, industry and society 25

Stepford Wives? 26

Safety 26

Unnatural advantages 27

Illicit substance use 27

Immunisation against the effects of psychoactive substances 27

Contents

Section III: Laying the ground 29

Introduction 29Regulating the use of psychoactive substances 30Approaches to regulation 31Initial understanding of the area 35The context of science 37The pharmaceutical Industry 37Prescribed psychoactive substances 38Legal recreational psychoactive substances 39Illicit psychoactive substances 40Attitudes of illicit psychoactive substance users 42Attitudes of young people 43

Conclusions 44

List of publications: Drugs Futures 2025? 46

Drugs Futures 2025?Public Perspectives

ii

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The Foresight project on Brain Science, Addiction and Drugs commissioned OPMto consult with members of the public and seek their views on psychoactivesubstances and the future. The findings informed the question set to itself by theForesight Brain Science, Addiction and Drugs project (BSAD):

How can we manage the use of psychoactive substances1 in the future to bestadvantage for the individual, the community and society?

There were three stages to the project:

1 six discussion groups – introduction to the issues

2 six workshops – exploring the issues

3 a one-day forum – exploring trade-offs and preferences.

Participants included members of the general public; people with, or caring forchildren with, ADHD; users of illicit psychoactive substances; young people fromschool year 9–13. Eighty-seven people took part in the project, and work wascarried out in Glasgow, Swansea, Derry and London during February and March2005.

The research explored attitudes towards four classes of psychoactive substances:

� mental health drugs

� mood-altering drugs

� pleasure drugs

� cognition enhancers.

Executive Summary

1 We understand a psychoactive substance to be 'any substance or surrogate intervention that affectsbrain function through its chemical neurotransmitters. The term includes recreational, psychiatric,cognitive-enhancing or mood-altering drugs and also future technology such as transcranial magneticstimulation or neural prosthetics' (Foresight BSAD general briefing, September 2004).

Because many substances fall into more than one of these classes, participantsfocused on the reasons for, and context of, use i.e.:

� medical use – to alleviate suffering, whether physical or mental

� social use – a majority of participants placed their own substance use in thiscategory

� illegitimate use – licit and illicit substances fall into this category

� lifestyle use – a majority of the substances in this category are seen as 'natural'and their use is approved on the grounds that it demonstrates care of self.

Participants' knowledge of science was not extensive but their attitudes towards itwere largely positive. Some concern was expressed about science 'going too far',with technologies such as cloning and nanotechnology being cited as examples ofthis. Genomics met with most scepticism. Some participants were unconvincedabout the possibility that specific genetic tendencies could be identified andmeasures taken to prevent or mitigate their future expression. The positive role ofpharmaceutical companies was acknowledged but there was considerable suspicionof the profit motive.

The group felt that the development of future policies in this area was best guidedby the principle of openness. Deliberative discussion of the benefits anddisadvantages of specific new technologies and of the general principles that mightgovern their use will contribute to improved decision making. These discussionsshould involve the public, specific interest groups, scientists and policy makers.

Three core trade-offs emerged during the course of the project:

� individual rights vs the rights of society

� community safety vs preventing a 'normalised' society

� preventing problems in advance vs dealing with problems as they arise.

Participants showed a preference for options that protected individual choice:

� they felt that limited awareness of how decisions that impact on individual livesare made engendered suspicion about 'them' – Government, science, andsociety itself

� ceding decision-making power on the use of psychoactive substances, especiallywhere these might have a coercive use, was seen as a possible invitation to lossof choice

� protecting people who are vulnerable, preserving public health, social order andcommunity safety were seen as vital. Equality of access and fair distribution ofresources were seen as elements in achieving such protection

Drugs Futures 2025?Public PerspectivesExecutive Summary

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� great concern was expressed over the use of psychoactives leading to a'normalised' society bereft of creativity and diversity. This was behind muchof the resistance to coercive use of drugs to manage behaviour.

Attitudes towards currently illicit psychoactive substances are informed largely bymedia coverage and are generally condemnatory. Arguments made in favour ofother psychoactive substances were rejected in the case of illicit substances, andparticipants with experience of ADHD, and illicit substance users, were more likelyto view illicit substance use as a form of self-medication.


Executive Summary

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4

This report presents the research in reverse chronological order: Section I reports on the final stage of research and the Section III reports on the first stage ofresearch. This structure will allow readers to gain a comprehensive overview of the research outcomes from the first chapter.

Section I offers the highest-level analysis of the debates that recurred throughoutthe research. These are articulated through the three trade-offs which capturedmost effectively the tensions that ran through discussions from the start of the project:




In addition, this first section outlines participants' suggestions on how the publicmight best engage with these issues in the future, including both howcommunication should take place and what information should be provided.

In Section II we look in more detail at some of the debates that led to the trade-offs. The information in this section is drawn from responses to a series of briefcase studies, each of which presented participants with a possible future substanceuse or with a revised approach to regulation – for example, the use of cognitionenhancers by employers as a way of regulating employee performance, or thelegalisation of currently illicit substances. The case studies were designed to placepossible future substance use in easily accessible and familiar contexts. Supportingmaterials accompanying the longer case studies provided participants withinformation to help them structure presentations that would require them to argueagainst some of the assumptions and views that had informed the first stage ofthe discussion. A full set of case studies is appended to the online version(www.foresight.gov.uk).

Section III provides details of the first stage of research. This was designed toprovide participants with an initial overview of the issues to be addressed duringthe project as a whole and to provide researchers with information on participants'understanding of and attitudes towards them. The focus was on the attitudestowards different regulatory models and reasons for regulation.

Organisation of report

Acknowledgements

Our thanks go to all the participants in the research and to others who contributedto its success, including:

� Jeyavani Atchuthan from the Heathland School, who organised contact with theyounger participants and gave up her own time to attend events

� Andrea Bilbow at ADDISS who organised contact with members of this groupand took part in the research

� Martin Ince, the project's science writer who provided valuable feedback onresearch materials and the report.

Objectives

This project was designed to inform the question set to itself by the ForesightBrain Science, Addiction and Drugs project (BSAD):

How can we manage the use of psychoactive substances in the future to bestadvantage for the individual, the community and society?

The primary objectives of the project were to:

� test the draft scenarios for robustness

� identify any reactions to future science or approaches to management whichmight have a significant impact on future policy

� explore whether there are any scenario-specific or cross-scenario outcomes thatwould be preferred

� identify any common principles from the discussions which might help to guidedevelopment of future policies in this area

� set out any key trade-offs which are identified

� explore how best to engage in discussions with the public on the issues raisedby the scenarios.

The scenarios intended to form the basis for this discussion were unavailable foruse in the project and their robustness could not, therefore, be tested. In theirplace, OPM, in discussion with the Foresight team, developed scenarios and casestudies2 that pulled out some of the issues of most importance to the project.These are appended to the online version of this report.



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2 Scenarios and case studies help people imagine the future more effectively. They highlight theuncertainties surrounding an area and explore how those uncertainties might play out in the future.

Approach and sample

A three-stage approach was designed for this project:

Stage 1: Discussion groups

� General public:

• Woolwich, south London (13)

– Social grade3 C2DE

– 8 female, 5 male

– 3 Asian, 1 Afro-Caribbean, 9 white

• Glasgow (14)

– Social grade BC1


– 2 Afro-Caribbean, 1 Pakistani, 11 white

• Swansea (15)

– Social grade C1C2


– 3 Asian, 3 Afro-Caribbean, 9 white

Stage 3: Forum:

• Developingresponses toscenarios

• Preferences,principles andtrade-offs

• Communicationapproach

Stage 2: Introducingscenarios:

• Four workshops(adults)

• One workshop(illegal drug users)

• One workshop(mentalhealth/behaviourmodification drugusers and carers

• One workshop(young people)

Stage 1: Exploringattitudes and issues

• Four discussiongroups (adults)

• One discussion group(illegal drug users)

• One discussion group(mentalhealth/behaviourmodification drugusers and carers)

• One discussiongroup (youngpeople)

Drugs Futures 2025?Public PerspectivesOrganisation of report

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3 Social grade (SG) is a classification system used by much social research in the UK. It classifieshouseholds according to the occupation of the chief income earner, as below:

AB Higher and intermediate managerial/administrative/professional

C1 Supervisory, clerical, junior managerial/administrative/professional

C2 Skilled manual workers

D Semi-skilled and unskilled manual workers

E On state benefit, unemployed

• Derry (14)

– Social grade C1C2


– All white

� Users of illegal psychoactive substances4 (3)

• London

– 2 male, 1 female

– All white

� Young people (15)

• The Heathland School, Hounslow


– 4 from years 9–11; 6 in lower-sixth form, 5 in upper-sixth form

� Users/carers of people using mental health/behaviour modification psychoactivesubstances (13)

• North London


– mixture of parents, carers, relatives of children with ADHD or having ADHDthemselves.

Stage 2: Workshops

� General public

• London (8)

• Glasgow (13)

• Swansea (13)

• Derry (13)

� Users of illegal psychoactive substances (1)

� Young people (14)

� Users/carers of people using mental health/behaviour modification psychoactivesubstances (11).



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4 Throughout this report, the terms 'drug', 'substance', 'psychoactive substance' and 'psychoactives' areused interchangeably.

Participants received a small 'thank you' of cash (or vouchers, for the young people)for Stages 1 and 2 of the project. Stages 1 and 2 took place in February 2005.

Stage 3: Forum

Eighteen people took part in the Forum. They came from Glasgow, Derry andLondon and included members of the national Attention Deficit Disorder Informationand Support Service (ADDISS) and eight young people from the Heathland School inHounslow. Those who attended were largely self-selecting and thus notrepresentative of the wider general public. It should be noted that the attitudesexpressed by those at the Forum tended to be more liberal than they were duringthe consultation as a whole, reflecting perhaps the nature of participants who wereable to travel to London. Many who would like to have attended could not do sobecause of family or work responsibilities. Others were not able to attend due toplaces being limited. Few showed no interest at all.

The Forum was held at the Institute for Mechanical Engineers in London onSaturday 12 March 2005. Participants' costs and expenses for travel to Londonwere covered.

Drugs Futures 2025?Public PerspectivesOrganisation of report

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Ideas of life in the UK in 20 years' time vary from individual to individual and dependon things such as access to information, their view of the world as it currentlystands, knowledge of global trends and understanding of history. Conventionalwisdom is notoriously difficult to escape and we analyse today's world with thetheories and concepts of the past. Looking into the future, we are likely to bringthose same theories and concepts to bear.

These difficulties are compounded when seeking to extend a vision of the futuredevelopment of an area about which the general public is at present under-informed. Science is remote from most people's lives, though it may touch themevery day through the technologies it makes possible. Attitudes towardspsychoactive substances, licit and otherwise, are informed largely by popular mediacoverage, which is, in varying degree, hysterical, devoid of context, over-complex,poorly presented for general audiences, or just plain incorrect. Occasionally, it mustbe noted, it is accurate and informative. Only those whose lives are beset byproblems that bind them on a daily basis to the products of science have the timeor inclination to seek out trustworthy information and follow new developments.

There are terminological hurdles to overcome too. The word 'drugs' is for mostpeople synonymous with 'illegal drugs'. To widen the field of reference by use ofthe term 'psychoactive substances' is to introduce a new and unfamiliar word intoan already complex area. In addition, the common terms for products in everydayuse can disguise their underlying make-up. This complicates discussion of, forexample, nicotine, which is almost exclusively thought of in terms of tobaccoand the damage caused by smoking. To accept that nicotine, associated withdependency and lung cancer, might have positive benefits, means overturningcurrent views. A first response to learning that diamorphine (heroin) is a highlyeffective and safe painkiller used in palliative care often meets with the response:but won't they become addicted?

All of this might suggest that attempting to involve the public in a project that aimsto explore the potential influences from society on how advances in science mightbe used and how science might shape the future management of psychoactivesubstances by society is a futile exercise. This is far from the case.

Introduction

The general public brings to this debate great enthusiasm and a fascination with thesocial and ethical questions it presents. While it might be true that discussions arebased on existing experience and knowledge – could it be otherwise? – and thatthe attitudes of some are entrenched, this is not really so different to similardiscussions among the 'experts'. The project demonstrates the capacity of thegeneral public to engage seriously with an intricate and involved topic, to amendtheir views in the light of information and to bring wit and pleasure to the process.Information overload can lead people to take refuge in familiar arguments: 'all drugusers are evil,' and 'scientists are not like us' being two of the most frequent boltholes. However, these retreats became less frequent as the project progressed andattitudes were revised. A young woman with ADHD talked to an A-level studentfrom Hounslow and an engineer from Glasgow listened to a front-of-house theatremanager from Derry; people shared experiences and this informal conversationenriched the overall debate.

Reactions to future science are largely informed, as noted, by existing knowledgeand attitudes. Past change is recognised; for example, in attitudes towardssmoking, and some forecast similar changes in attitudes towards alcohol. However,for the most part, the present persists and frames debate. For example, discussingcognition enhancers, participants familiarise themselves with the idea of usingpsychoactive substances for this purpose by reference to current herbal or otherover-the-counter preparations. Changing attitudes and possible future changes areacknowledged and then put aside.

Participants with ADHD, or with experience of it through caring responsibilities,were extremely well informed as a result of personal investigations into the scienceand medicine that might deliver them positive, and sometimes not so positive,benefits. Many of the younger people showed considerable faith in science. Allstudying one or more sciences at A level, they were accustomed to discussingscience and related issues and aware of contemporary developments. Youngerparticipants were also the only group to raise the question of conflict betweenscience and religion. Older participants who had lived through or been personallyaffected by the thalidomide disaster, food scares or medical errors tended to bemore sceptical. Their reactions to future science combined curiosity, anticipationand wariness.

Of the science relevant to this project, the most difficult to accept was thepossibility that knowledge about the human genome would allow for theidentification of specific individual predispositions and that steps might then betaken to prevent their expression. This in itself indicates something about the extentof existing knowledge. Only those who had personal experience of this technologycould accept easily that this is likely to have a major impact on future science in thisarea – for example, the woman who had had breast cancer in her thirties and wasnow considering genetic testing for her daughter.

Drugs Futures 2025?Public PerspectivesIntroduction

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The principal standard for future policy development to emerge from the project isthat of openness. Clarity of intention, provision of lucid information, explanation ofthe reasons for taking a particular policy direction, public access to candid andcomprehensible scientists and a willingness from all involved to respond to andaddress public concerns are all aspects of this.

Openness is also at the heart of a trade-off which was not discussed in the project.Acceptance, or at least understanding, of scientific and pharmaceutical developmentis more likely to be forthcoming if the public can see evidence that its views havebeen heard and played a role in these developments. A possible and understandabletemptation would be to go the other way and refrain from public engagement, ongrounds either of the difficulties of the topic or for fear of suggesting certaintywhere none exists. The most interesting and knotty arguments lie on the thresholdof uncertainty. This researcher believes that an emphasis on openness willencourage public recognition that science does not and cannot provide solutionsto all that ails society and that it thrives best when certainty is missing. That iswhen the testing questions arise. In terms of policy, enabling and encouragingparticipation in debate and discussion of these questions will not only help toincrease understanding of science as a pursuit but also lead to improveddecision making.

A concern raised early in the project was that of the 'poor use of good science'.Though the precise intricacies of the science itself may be difficult for non-expertsto get to grips with, the social implications of the use of psychoactive substancesdeveloped on the back of that science are not.

The research explored attitudes towards four classes of psychoactive substance:

� mental health drugs

� mood-altering drugs

� pleasure drugs

� cognition enhancers.

Many substances fall into more than one of these classes and discussion overthe course of the project reflected this. Matters pertaining to any one class weredifficult to isolate from those relating to the other three. Participants attendedinstead to the reasons and context behind use and divided these into four broadgroups:

1. Medical use

Use of psychoactives to alleviate suffering, whether physical or mental, waslargely uncontroversial. While there was some concern about over-reliance onpharmaceutical solutions to health problems, this tended to relate only to minor


Introduction

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conditions that might be relieved by increased exercise, an improved diet or otherchanges to lifestyle. Use of psychoactives for these lesser conditions was seenas opting for a 'quick fix'.

More controversial was the range of substances that might be included in thiscategory. For a majority, it was confined to prescription-only drugs and over-the-counter drugs for headaches or flu. For those using illicit drugs and forparticipants with ADHD, or caring for someone with ADHD, the picture was lessstraightforward. They argued that many people turn to illicit substances tocounter mental suffering in particular.

2. Social use

A majority of participants placed their own substance use in this category.Moderate and involving only licit substances i.e. alcohol and nicotine, social usewas seen as largely unproblematic. But attitudes towards nicotine use havehardened and for many it has come to occupy a space on the boundary betweensocial and illegitimate use. The only query about the overall legitimacy of thecategory itself was voiced by the young people. Their disapprobation was dueat least in part to religious or cultural beliefs.

3. Illegitimate use

Licit and illicit substances fell into this category. All the following were seen asillegitimate:

– cognition enhancers to improve children's performance in exams or to makeemployees perform more productively

– chemical blockers designed to nullify the effects of illicit substances

– illicit substances themselves (heroin, cocaine, ecstasy, cannabis,amphetamine)

– licit substances acquired off-prescription.

Added to this was over-consumption of alcohol, such that users becomedependent and of potential harm to either themselves or those around them.As noted above, nicotine use is also becoming more suspect.

4. Lifestyle use

This category is the most imprecise of the four. It includes substances taken toaddress stress, to improve mental functioning (e.g. ginseng, ginkgo biloba) orgeneral health (vitamin and mineral supplements, herbal preparations such asechinacea) and to help people 'start the day', which generally means consumingcaffeine. A majority of the substances in this category were seen as 'natural' andtheir use was approved on the grounds that it demonstrates care of self.

Drugs Futures 2025?Public PerspectivesIntroduction

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The distinction between 'natural' and 'unnatural' substances is behind thedifficulty in defining lifestyle use, since use of 'chemicals' for the same purposewas frowned upon. The distinction between a natural psychoactive substanceand a chemical one was made with reference to production. At what stage in theproduction process a substance derived from a natural source becomes unnaturalis unclear.

The collision of category of use with the natural/unnatural distinction is either lessevident or absent in the case of categories other than lifestyle. For example, it didnot arise at all in discussions of illicit substance use, where illicit means 'currentlynot legal', perhaps because knowledge among the general population of theorigins of these substances is limited. However, it does appear to play a role indistinguishing between illicit and licit lifestyle use. 'Natural' cognition enhancersare seen in a different light from 'chemical' cognition enhancers. The distinctionappears to be unproblematic in medical use, perhaps because it is overridden bythe recognition that relief of suffering and restoration of health are toofundamental to tolerate such a nice distinction.

Power plays a critical role in debates and most participants thought its distribution was not in their favour. Two things underpin this view. The first islimited knowledge; 'they' (scientists, government, pharmaceutical companies)know more than us. The second is suspicion about the intentions behindprinciples implying structures that would potentially impede individual choice,whether these are social, political or economic. Participants were morecircumspect about options that appeared to favour social or community intereststhan they were about those that privilege individual rights.

Fear of impotence in the face of science and Government coexists with thedesire for both to offer reassurance. Desire is strongest in areas of greatestuncertainty. The law provides the greatest reassurance, serving as a boundaryagainst uncertainty and against the need to entertain or make arguments that run against the stream of wider opinion. Or at least, the law as it currently standsprovides reassurance, most particularly in discussions of the pros and cons oflegalising controlled substances which are often ended by reference to the law.Controlled substances provide a counter-example to the prevailing view thatindividual choice should be privileged. The prospect of future laws regulatingsubstance use, which might potentially restrict individual freedom of choice is less reassuring. As noted above, confusion in this area might be reduced, if not resolved, if the public was engaged in debate on future legislation – and on whether there is a need for it.


Introduction

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14

Introduction

Section I offers the highest-level analysis of the debates that recurred throughoutthe research. These are articulated through the three trade-offs that captured mosteffectively the tensions that ran through discussions from the start of the project:




Before looking in detail at the debates surrounding the trade-offs, this first sectionoutlines participants' suggestions on how the public can best be engaged withthese issues in the future. In addition to involvement processes, includingworkshops and seminars, these suggestions cover how communication should takeplace and what information should be provided.

Talking with the public

Overall, participants showed a preference for options that protect individual choice.This was not, however, because they have no care for society. Rather, lack ofinformation about and understanding of how decisions are made that impact onindividual lives engenders suspicion and anxiety over 'them' – Government, scienceand sometimes society itself. In all three trade-offs, ceding decision-making poweron the use of psychoactive substances, in particular where these might have acoercive use, was seen as a possible invitation to loss of choice.

For choice to be exercised responsibly and for individuals to understand theramifications for wider society of their choices, information and dialogue isnecessary, in particular with scientists and policy makers. At the end of the Forum,participants posted notes on the information they would like communicated to themand on the type of dialogue they would like to have. Members of the ADDISS grouphad quite specific requirements and asked for quite detailed information. This maybe something they share in common with others who have an ongoing health need.ADDISS comments have been noted separately. Table 1 and Box 1 show thesuggestions made by participants.

Section I:The Forum

Table 1: Communication suggestions from participants

Box 1: Information requests from participants from ADDISS

� Undertake surveys and research that are relevant, to prove drugs are reliable;censor poor media 'hyping' drugs

� Make new-product updates easily available

� Provide information on addiction and current developments in knowledge andtreatment (including addiction to prescribed drugs)

� Give information on the reasons for prescribing certain drugs and expectedeffects of use

� Make current developments in science known

� Make available all information about a particular drug i.e. the positive and thenegative, including:

– the probability and nature of side-effects

– chemical make-up of drugs

– scientific name of drug (not just the brand name)

– known uses for drug.

Even information which appears useless may be of great use to an individual user.

WHAT TO COMMUNICATE HOW TO COMMUNICATE IT

The reliability of scientific information Use the media, including advertising:� TV� Internet� Newspapers� Radio

How to keep fit – promote a healthier lifestyle On packaging – simplify and expand information

Benefits and disadvantages attached to On books, leaflets and drug packaging psychoactive substances (prescribed and over-the-counter) Through education in schools and through GPs

Health forum with doctors and nurses, for In workshops different age groups

NOTE: there is no correlation between the two columns – appropriate medium will depend onaudience, content to be communicated, reasons for communication etc. This applies also to thechart on the following page.


Section I: The Forum

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The opportunity to discuss the issues surrounding the management of psychoactivesubstances was seen as something that should be offered more widely. Involvingsympathetic experts able to translate complex scientific developments or policydecisions is crucial. Professor Trevor Robbins, a science adviser to the project,attended the Forum and demonstrated clearly the value of involving experts with agenuine interest in hearing the views of the public. In addition to conveying in alucid manner up-to-date information on developments in the area, Professor Robbinswas enthusiastic about joining in discussions and responding to questions. This wasof unmistakable value to the participants.

Finally, dialogue is seen as something that should take place primarily at a local level(see Table 2).

Table 2: Dialogue suggestions from participants

Exploring the trade-offs

While the range of debates widened as the stages progressed and participants tookon or argued against others' opinions and developed or reconsidered their own,some central themes shaped participants' views and were consistent throughoutthe entirety of the project. The three trade-offs:



� preventing problems in advance vs dealing with problems as they arise

WHAT DIALOGUE SHOULD COVER HOW DIALOGUE SHOULD TAKE PLACE

How to reduce dependency on drugs In workshops and seminars; education in schools

Discussion on the good and bad effects of With GPs and pharmacists and scientistsdrugs; how drugs work and the dangers associated with them

Advances in research

Everything to do with drugs, legal and illegal; In easily accessible venues, for example, local health issues and scares about drugs health centres

Discussion about removal of prohibition Through mailing campaigns, telephone calls orone-to-one discussions

How certain drugs are performing Through community projects or websites

Long-term effects; research evidence; In parliament and the mediahow regulation would work

Drugs Futures 2025?Public PerspectivesSection I: The Forum

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captured these themes and provided a spine for debate in the Forum. Before andafter the debate, a ballot was taken to see where each participant stood in relationto the three trade-offs. A scale of 1–10 in the direction of either argument was used(see Figure 1). Each participant had a numbered, coloured dot which they placed atthe point on the scale they felt best represented their position.

Figure 1: Example of scale for trade-off 1

The numbers on the bars in Figures 2 and 3 are the sum of the positions in whichindividuals placed themselves on the scale for each trade-off. For example, on thescale in Figure 1 for trade-off 1, one individual might place themselves at '5' infavour of individual choice. Another might place themselves at '5' in favour of therights of society.

Between the first and second ballot, attitudes shifted quite considerably on all threetrade-offs (compare Figure 2 to Figure 3).

Figure 2: Results of the opening ballot

Individual choice Rights of society

Prevent a 'normalised' society

Deal with problems as they ariseAdvance prevention of problems

43 19

32 36

50 26

Ensure community safety

10 9 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 9 10




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Figure 3: Results of the closing ballot

The debates that led to the closing ballot were complex, informed and interesting.Participants worked in three small groups to explore the benefits and disadvantagesof each pole of the trade-off, through three scenarios, each of which presented adifferent possible future. Each group looked in turn at one trade-off in relation to onescenario and then moved onto the next scenario and trade-off.

The closing ballot shows opinion consolidating around the poles which privilege theindividual. Individual choice is valued more highly than the rights of society as a whole;an eccentric (that is, not 'normalised') society, which might include dangers anddiscomfort, is valued more highly than community safety; and finally, an approach thatdeals with problems as and when they arise is preferred to attempts to prevent themarising in the first place. It should be noted, of course, that this ballot is taken toreflect the views of participants only on the issue of managing the use ofpsychoactive substances. To what extent it reflects their wider views is not known.

Individual choice vs the rights of society

The final ballot suggests a straightforward preference for individual rights over therights of society. However, it is important to dig beneath the rating scale to get amore accurate picture of participants' views.

Supporting the right of individuals to make their own choices was seen as a way ofcontributing to community diversity and vibrancy, rather than as leading to fracture,isolation and selfishness. Protecting people who are vulnerable, and preservingpublic health, social order and community safety were seen as vital but the


Prevent a 'normalised' society

Deal with problems as they ariseAdvance prevention of problems

Ensure community safety

79 6

5 60

13 47


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difficulties of reconciling individual choice with the wider well-being of society wereacknowledged. Participants' preference appears to be based on the assumption thatthe rights of society will fall out of the individual exercise of choice. In contrast,giving privilege to the rights of society is seen as leading to the restriction ofindividual choice.

This concern is evidenced in some of the comments posted in favour of individualchoice. One participant referred to the dangers of a 'police state' and othersexpressed similar worries about having to cede their right to make decisions abouttheir own life and future to 'faceless bureaucrats'. As the options for regulation werediscussed, distrust of governance grew and support hardened for individual choice.

Substances falling within the category of illicit use (Category 3, described in theIntroduction), present the greatest challenge to the preference for individual choice.This difficulty tends to be circumvented by reference to legal status; use of non-medicinal substances is either prohibited, as in the case of cannabis, for example, orits distribution is controlled. Reference to the law serves to close discussion of itsuse for reasons other than personal shortcoming or misguided hedonism. However,as some of the participants from ADDISS pointed out, these substances may beused by people with mental health problems to alleviate their condition, eitherbecause prescribed drugs are found inadequate or because conditions are notrecognised and go untreated. This highlights the importance of context of use overthe specific nature of the substance itself.

Advance prevention of problems vs deal with problems asthey arise

The positive aspects of advance prevention were seen as limited. Participantsfocused on the social benefits of eradicating 'selfish' lifestyles or habits – forexample, smoking or substance dependency. In the extreme case, an advantagewas seen in being able to identify people who may at some future point be a realdanger to society, as suggested by one of the scenarios (Testing new ground).

Concerns raised about the preventive use of psychoactive substances related bothto the individual and to society as a whole. For the individual, the downsides wereseen as the possibility of long-term negative effects arising from the use ofpreventive vaccines; removal of choice; lack of access to potential future andpositive uses of a drug, the effects of which an individual has been immunisedagainst (nicotine was cited as an example); possible changes in personality; andfinally, the use of a drug to deal with a problem that might be better dealt with byother means.

Identified disadvantages to society of the preventive approach included loss ofdiversity and opaque decision-making processes. The elimination of what wereacknowledged to be possibly dangerous habits or proclivities was seen as leading to



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a less interesting society. Participants were clear that hazard is part of life and thatthe attempt to eradicate it completely is likely to produce a dull and uniform world.This argument did not, however, apply to the use of illicit substances.

Who makes decisions, how and for what reasons are questions that recurthroughout the project. Suspicion about government, and a tendency among someto use 'government' and 'society' as synonyms gives rise to the fear that individualsalready seen as relatively powerless will be further weakened if societal rather thanindividual needs are favoured. The power of science, of the pharmaceutical industryand of the black market, and this cautious attitude towards government combine togenerate anxiety about any steps that appear to be removing choice. Advanceprevention appears to be seen as one of these steps. There is support for voluntaryuse of this technology but assurances of safety are required.

If drugs are designed to combat deviant behaviour, where does it stop?

Yesterday's deviants are today's philosophers!

Participants favoured dealing with problems as they arise.

The changeable nature of society is seen as something to value and protect. Since thesubstances under discussion act on the brain, concerns arise over the possibility thattheir use will affect personality in a manner that will reduce the capacity of society tochange. Some respondents identify cost benefits to this approach too, arguing thatadvance prevention might mean that resources are wasted on people who might notgo on to develop any problems. This points to a further theme that persisted throughall three stages of the project, that of uncertainty over how risk and benefit areassessed. While the reason for immunising babies against future illness is wellunderstood, the prospect of immunisation that impacts on the way the brain works isseen as more threatening and, perhaps, the balance of benefit and risk vieweddifferently. The brain is implicated with personality and a major anxiety is that advanceprevention will alter this in unknown, unwanted and perhaps permanent ways.

The principal downside of waiting until problems arise before addressing them isthat, by that stage, it may be too late to do anything.

A combined approach was suggested by one participant. This approach wouldgather genetic data and identify potential problems but, rather than seeking toprevent them before they arose, the individual would have access to health-monitoring processes, support, guidance and advice so that problems could eitherbe avoided completely or be identified and treated at an early stage.

Members of the ADDISS group in particular felt there was a need for morecompetent professionals and more money in the mental health field and saw thisin itself as a form of advance prevention.


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Community safety vs preventing a 'normalised' society

This trade-off was designed to explore concerns that psychoactive substancessuch as cognition enhancers and behaviour modifiers would lead to a 'normalised'society from which eccentricity and creativity had been squeezed out.

The limited benefits associated with privileging community safety are reduction incrime and the consequent reduction in harm to the individual. The negatives wereexpressed more forcefully and included the possibility that parents might becriminalised if they refused to immunise children whose genetic make-up identifiedthem as a potential future danger. Current attitudes towards brain dysfunction andmental illness, which members of the ADDISS group were clearly familiar with, alsoinformed views. Their fear was that people with epilepsy or perhaps even diabetesmight end up being targeted in the interests of 'community safety'. Somepresented a 'slippery slope' argument. Once the use of a substance is acceptedin one field, it is more easily transferred for use elsewhere. Once a substance isaccepted for the prevention of medical problems, its use may be seen as moreacceptable for the prevention of social problems. The boundary between the two isnot sharp and the impact on individuals of its being drawn in a particular place maybe severe. The costs of an eccentric and varied community may start to suggestuse of psychoactive substances to address mental health problems such asdementia, Alzheimer's or even just old age, not in the interests of the individualsthemselves but for economic reasons. Compulsory treatment, the use ofpsychoactive substances by the criminal justice system and their use as 'quickfixes' were further worries.

The anxieties generated by a community safety approach were expressed in thesame terms as those used by some participants in relation to developments inscience: 'where does it stop?' As knowledge grows, along with the ability ofscience to intervene in what is seen as 'natural', so, too, do worries about thecreation of a society of clones and, possibly, worse.

How many people are a danger to society? This is a blanket approach.

It'll be a 'bipolar society', normal and abnormal – no variation!

Preventing a 'normalised' society

From what has been said above, the arguments made in favour of this will beapparent. Some pointed out that community safety and preventing a 'normalised'society are not necessarily incompatible; whether they are depends on the uses towhich future psychoactive substances are put.



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Introduction

In Section II we look in more detail at some of the debates that led to the trade-offs. The information in this section is drawn from responses to a series of briefcase studies, each of which presented participants with a possible future substanceuse or with a revised approach to regulation – for example, the legalisation ofcurrently illicit substances or the use of cognition enhancers by employers as a wayof regulating employee performance. The case studies focused on exploring issuesraised in the discussion groups and were designed to elicit participants' responsesand attitudes to potential future developments in psychoactive substances,genomics, brain science, social attitudes and legislation. Further information wasprovided to aid discussion and help participants think outside the familiar landscapeof 2005. The difficulties inherent in attempting to second-guess future attitudes andbehaviours, combined with the complexities of the subject matter itself, suggestedcase studies that were couched in terms of individual experiences with whichparticipants could identify or at least recognise.

In the period between the first and second stages of the project, some participantsread materials made available at the end of Stage 1 and many participants had paidmore than usual attention to related issues covered in the media. They had giventhought to how different substances were regulated and to the possible effects ofsome everyday consumer products. For example, chocolate was described by oneparticipant as releasing 'happy hormones' in the brain. There was also considerablesurprise at recent coverage in the media of illicit psychoactive substances use bypeople who were seen as falling outside the media stereotype of the 'junkie' or theperson whose life had been destroyed by drugs – recent media coverage of middle-class drug users.

The case studies

Overall the case studies were seen as believable. The dilemmas they presented andthe science behind them were thought to be realistic and they generated interestingand thorough debate.

Developments in genomics were seen by a majority as the least convincing aspectof the science behind the case studies. Some participants were sceptical that it

Section II:Debating the issues

would have developed sufficiently, even over the next 20 years, to provide accurateinformation on the predisposition of an individual to develop a dependency onparticular substances or for personalised psychoactive substances to be available inthat timescale. This scepticism may, at least in part, arise from the tendency amongparticipants to see dependency in terms of personal moral failing rather than ashaving any underlying physical basis. The question of the relative importance ofgenetic make-up and social and environmental triggers or influences on thedevelopment of dependency was raised in the first stage. A majority of participantsblame dependency almost exclusively on poor parenting giving rise to poor decision-making skills in later life, or to other environmental factors. The puzzle of why twochildren, growing up in very similar environments, may go on to have completelydifferent futures is one to which, for many, genetic make-up is not the mostimmediate answer – though an answer would be welcome.

The difference between the disposition to develop dependency and 'having a genefor addiction' was also unclear to some participants. The exception to this was theADDISS group, whose knowledge of this area in general was far greater than that ofmany other participants. This suggests there is a need for greater clarification in thisarea, particularly since some technology in this area currently exists. While themoratorium on the use of predictive genetic test results by insurance companieshas recently been extended to 2011, future public debate on this issue will requiregreater knowledge than appears currently to exist.

I think it's a bit of a cop out saying [dependency is] a gene thing – it makes it somebody else's fault.

Two boys growing up together, going to the same school, one takes drugs,one doesn't, one smokes, one doesn't. Why is that, when they're both from

the same environment? Is it from the house? Is it from peer pressure? Is it because the parents smoke in one house and not in the other?

Research into that is important.

Aside from these two issues, the debate on the case studies focused primarilyon the social and personal implications they raised.

Issues raised by the case studies

Context of use

As noted, attitudes towards psychoactive substances are, for the most part,influenced by the context of use rather than by the specific properties of thesubstance itself. This is most clear in the case of illicit drugs that have beneficialuses. Many of those in the ADDISS group, of people with or caring for people withADHD, recognised the harm caused by cocaine, but pointed out that it can have a


Section II: Debating the issues

23

positive effect on some ADHD sufferers. Attitudes are also affected by views of theuser and their motivation for use – though, again, this is complicated in the case ofillicit substances. Acceptance of their legal use for medical purposes appears lesseasy, because of their current controlled status and the prevailing view of theinevitable consequences of their use.

Accepting new substances appears easier if they are used for already-establishedreasons. This was clear in the case of cognition enhancers. Participants referred toherbal preparations and some over-the-counter drugs with widespread current use.Understanding the circumstances in which they are used and the reasons for theiruse seem to be stronger influences on attitudes than the substance itself, with theproviso that safety and no risk of dependency need to be assured. Some couldaccept the use of cognition enhancers on safety grounds too. Discussion of anarticle about pilots using a drug developed for Alzheimer's Disease led to theconclusion that this was quite acceptable since it would make travel safer. This useappears to be in a category of its own.

It's got to be a good idea, if they're more alert and better at their jobthen we're all safer because of it.

In some contexts, use of psychoactive substances was seen as 'unnatural'. This isaddressed in more detail later in this section.

The use of psychoactives on children for reasons seen as non-medical – forexample, to address concentration problems or 'naughtiness', was seen asillegitimate, for three primary reasons.

First, it is viewed as an easy way out, possibly leading to a worsening of anunderlying problem of which this behaviour was a symptom. Related to thisargument was the worry that, as new substances are developed, people willincreasingly look for a 'quick fix' to life's stresses and abdicate responsibility fortheir children, medicating rather than taking the time and effort to resolvedifficulties without the use of drugs. The exception to condemnation of the use ofpsychoactive substances for 'concentration' problems was children with ADHD.A majority of participants recognised that psychoactive substances could makea huge difference to their ability to participate in normal childhood activities andsaw their use as purely medical. However, some participants questioned whetherADHD was a 'real' problem or a consequence of poor parenting. ADDISSparticipants were aware of this scepticism and challenged it.

Second, non-medical use of psychoactive substances on children was seen asunacceptable for reasons of safety. The tests for safety are more stringent forchildren than they are for adults and the long-term consequences of substance useof more concern. Cognition enhancers that are used to improve exam performance,for example, is looked on very harshly.

Drugs Futures 2025?Public PerspectivesSection II: Debating the issues

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Finally, the freedom of children to choose what to take or not to take is likely to bemore limited than that of adults.

Science, industry and society

Participants wanted science and pharmaceutical companies to recognise the socialcontext in which they operate. They wanted public involvement in discussionsabout the development of new psychoactive substances at an early stage andopportunities to learn about and debate possible uses and their potential impact onsociety as a whole. There was great concern over fairness and equality in thedistribution of drugs and resistance to the idea that private profit might takeprecedence over social well-being.

Increased scientific understanding of the human brain and genetic make-up wasseen, on the whole, as socially beneficent. Science itself was viewed as largelyneutral; the use to which its products are put and the profits accruing to those ablesuccessfully to exploit them were treated with more suspicion. One of the benefitsto society from growing scientific knowledge is the development of morepersonalised drugs which were seen as potentially both more effective and safer,since they are less likely to be used on individuals in whom they could triggerunpleasant or dangerous side-effects. The link between this and the capacity toidentify and treat potential problems on the basis of genetic information wasnot made.

Pharmaceutical companies were seen as benefiting in a range of ways from thefuture development of new psychoactive substances. Higher profits are the primarybenefit to them and the drive to profit was seen as potentially leading companiesto bring products to market before they have been tested exhaustively. Thalidomideis still used by many as an example of the devastating consequences of notconsidering 'all the angles'. Other benefits include a boost to corporate reputationthrough association with leading products, and an increased workforce.

The debate that gave rise to the most heated expression of the need to ensureequality and fairness, in both the development of new psychoactive substances andaccess to existing ones, surrounded a case study involving the cessation ofresearch into drugs for Alzheimer's Disease. This was on the grounds that thequality of the increased lifespan made possible by cognition enhancers was notsufficiently great to warrant the cost of continuing research. The resources releasedwere to be put into research into drugs to relieve chronic conditions among theyounger population such as diabetes and asthma. This infuriated some participantswho saw it as unfair to restrict the development of possibly beneficial substanceson such grounds. They were incensed, in particular, because they felt that olderpeople had paid into a system over a long period of time and deserved to be welltreated by it in return. Some questioned whether they should even be discussing



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such a controversial issue. Participants in the ADDISS group were most annoyed,perhaps because they are closer to the impact on their lives of decisions aboutwhere to target resources. Some remarked, only half in jest, that this could be theirown future.

Stepford Wives?

There was considerable concern about psychoactive substances leading to a'normalised' society, in which individuals, whose behaviour does not closely alignwith certain norms, would be coerced into using substances to rectify theirpeculiarities. The term 'Stepford wives' was used to describe people adjustedin this way. Some participants felt that dependency itself may have benefits,suggesting that the struggle to overcome it can lead to stronger individuals. Therewas also some suggestion that the creativity within society would be eliminated ifpeople's freedom to behave oddly, which might include taking illicit substances,were removed completely. For a majority, however, the current law, together withmedia coverage of illicit drugs, tends to mean that discussion of any benefitsattaching to their use are closed down by reference to their legal status.

Safety

The safety of psychoactive substances is a crucial matter. Participants pointed todeclining trust in science and doctors which, in part, was seen as a consequenceof the coverage of the MMR debate and BSE. Understanding of risk is limited andaccess to level-headed discussion of these high-profile cases may be hard to findfor many people. Their willingness to accept the assurances of GPs and scientistsabout the safety of newly developed drugs may be affected by this.

Dependency and unknown side-effects were the primary concerns. Dependencywas a frequent concern raised in the early stages of discussion about possible newsubstances and new uses for existing substances. Speculatively, this is linked tothe desire to retain individual choice, with dependency leading to the limitation of,or less choice. Unknown or unanticipated side-effects are more acceptable ifsubstance use is for the alleviation of a severe medical condition.

Other issues raised included 'getting wired' as a consequence of taking cognitionenhancers, resulting in the use of other substances to counteract their effect.These worries were highlighted in discussions of the use of psychoactivesubstances to improve quality of life, rather than to address a medical condition.Arguments against these drugs were made primarily on the grounds of safety.


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Unnatural advantages

Case studies involving cognition enhancers often led to discussions about their usebeing 'unnatural'. There was little explicit moral condemnation of this class ofsubstance, perhaps, as mentioned elsewhere, because substances to 'keep youalert' or 'improve your brainpower' are available commercially and used by thepublic at large. However, many participants made a distinction between thesubstances that are currently available, largely in healthfood stores, which areseen as natural and therefore as harmless, and cognition enhancers. The latterwere seen as drugs while the former were not.

The distinction appeared to be based on the nature of production undergone bya substance. A substance synthesised in a laboratory stands at one end and asubstance picked from a garden or from the wild at the other. There was no clearline between 'natural' and 'unnatural'.

In addition to the unnatural nature of the substance itself, its use was seen asproviding unnatural advantages and this in itself was thought to carry a risk. It mightbe that the benefits were not seen as sufficient to warrant the potential risksinvolved. This is not an issue that arose in discussions of the use of psychoactivesubstances for recognised medical needs. However, there was clearly also a deeperfear, which attaches also to genomics, that 'messing with nature' can carryunspecified and perhaps dire consequences. 'Nature' in this context is situatedinside the body and, more specifically, in the brain.

Illicit substance use

The media was seen as having great power in shaping debate on illicit substanceuse and some participants acknowledged that their views were based on mediacoverage alone. The use of illicit psychoactive substances was seen as leadinginevitably to problems, ranging from dependency, to criminal activities, to neglect offamily. Those using illicit substances argued that the current approach demonisesusers and that there is inadequate recognition of the reasons for use. They arguedfor a public health approach, based on the needs of the user looked at in the round,rather than simply on their dependency. Other participants recognised the legitimacyof arguments in favour of legalisation, but their gut reactions were strongly against it.

We have free will. We are all thrill seekers. Whether it's legal or not, peoplewill still buy drugs.

Immunisation against the effects of psychoactive substances

Support for immunisation either to prevent a potential future dependency or to blockthe effects of specific substances was very limited, primarily on the grounds that it



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would infringe freedom of choice. Even where people were making decisions thatwere harmful either to themselves or to others, the majority view was that it isnecessary to protect freedom of choice.

The majority concluded against childhood immunisation of this type after discussionof a range of issues. Parents' desire to protect their child against harm and therelease of money for the health service were given as possible arguments in favourof immunisation. On the other hand, safety was a major concern; the fear that theimmunisation itself might have unintended negative effects was voiced. Even ifthe effects of some substances could be blocked, a genetic predisposition todependency could lead to use of other, more dangerous substances. They alsothought that limited knowledge and some scepticism of science in this area,combined with uncertainty over whether a predisposition to dependency wouldlead to actual dependency and the removal of future choices for the recipient.The ADDISS group pointed out that, unlike MMR, debate around which was framedwithin the context of public health, immunisation against potential future substancedependency was a human rights issue.

The already-noted scepticism about genomics was also central to the above debate.

This looks like technology getting out of control – can lead to further problemsin the future with negative outcomes.

People must be able to make their own decisions, even if they are the wrong ones.

If it's someone's free choice to kill themselves by diving off a mountain, then it's the same with smoking.

Using blocking vaccines on illicit substance users, in the interests of protectingthe wider community against crime, was also viewed negatively. It was seen ascoercive, open to abuse by authority and, in the end, ineffective for reasons similarto those voiced above. Those with the inclination to use illicit substances would findother drugs to use in place of those rendered ineffective by a blocker. There was,however, considerable support for voluntary use of blockers.

The Government is too corrupt to execute it fairly.

People in positions of authority would be using it indiscriminately and for self-gain.

Everybody's entitled to human rights, even prisoners. It's not ethical or moralto force them to do this.


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Introduction

Section III provides details of the first stage of research. This was designed toprovide participants with an initial overview of the issues to be addressed duringthe project as a whole and to provide researchers with information on participants'approach to some of the background issues involved in managing the use ofpsychoactive substances. Understanding of and attitudes towards possibleapproaches to regulating substance use were explored. Knowledge, experience,attitudes and concerns about science, the pharmaceutical industry and differenttypes of substance use were also discussed. This information provided initiallearning on the issues that might be most profitably addressed in the case studiesand scenarios to be used in later stages of the research.

Participants had not been told the precise topic they were to explore. On arrival at thediscussion groups they were both curious and a little apprehensive. However, they didknow that the project had been commissioned by the Office of Science and Technologyand were enthusiastic about being involved in discussions that would contribute togovernment understanding of public perceptions in this area. Some expressed surprisethat the public would be given the opportunity to take part in this kind of event.

Once informed of the topic of the project, participants showed great interest. Whilespecific knowledge was quite limited, many were aware of relevant media coverageand brought personal experience to bear. Media coverage mentioned at this earlystage included:

� the decision by the National Institute of Clinical Excellence (NICE) to withdrawfrom use some of the psychoactive substances prescribed to people withAlzheimer's Disease

� the debate over the benefits and disadvantages of methylphenidate e.g. Ritalin,for children with ADHD

� research on heroin use by Glasgow Caledonian University.

Several participants were also nervous about their ability to contribute much to thedebate, feeling that their knowledge of science was too limited to allow them totake part in the discussion. However, nervousness soon passed. Debate wasanimated, purposeful and, at times, heated.

Section III:Laying the ground

Regulating the use of psychoactive substances

Participants supported regulation in some form, but recognised that each methodwould bring with it some disadvantages. The tension between preserving the rightof individuals to make choices over the psychoactive substances they might useand protecting the rights of wider society was evident in the earliest stages of theproject, though arguments initially favoured societal rather than individual rights.Underlying the explicit concerns raised, there seemed to be a largely, though notcompletely, unspoken worry that regulation would be made against the interests ofindividuals who had little power. This concern ran through each stage of theresearch.

Participants in the ADDISS group expressed this fear most forcefully. Their attitudeto the use of illicit psychoactive substances was noticeably different from that ofother participants (apart from the users of illicit psychoactive substances ), sincethey were aware that some substances that may be of benefit to them wereavailable only through black market sources. This had a considerable impact on theirviews. The ADDISS group members appeared to place illicit substances at theboundary between medical and illegitimate use, rather than wholly within thecategory of illegitimate use. Younger people tended to see both Government andtheir parents as wholly benign and acting solely in their interests.

In all groups and in most discussions at this early stage of the project, the focustended to default to illicit psychoactive substances and the debate on regulationwas no exception. Language is partly responsible for this. Despite encouragementto use the term 'psychoactive substances' rather than 'drugs', throughout theproject, participants fell into shorthand and used the term 'drugs' which theyassociated primarily with heroin, cocaine, crack and cannabis. However, conclusionsthat seemed workable in the case of illicit psychoactive substances became lesstenable when considering both currently legal recreational substances or vitaminsand herbal regulations. Cases made against the use of illicit substances could alsobe applied to licit recreational drugs such as alcohol. Despite recognition of the highcosts attached to the use of alcohol and tobacco, however, their legality protectsusers from association with the dependency and degradation they associate withthe use of illicit psychoactive substances.

In discussing regulation, participants returned continually to two issues. The firstwas education for young people on the potential harms of recreational psychoactivesubstances, licit and illicit. Many felt that this was currently inadequate and thatreliable information should be more widely available. While a few participantsargued that young people would experiment with drugs, no matter how good andwidely available information was made, this was not seen as a reason for failing toprovide it.

Drugs Futures 2025?Public PerspectivesSection III: Laying the ground

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The other question concerned dependency. The extent to which a substance leadsto dependency or requires the use of other drugs to mitigate its effects was acrucial factor in attitudes towards managing use. For example, presented with ahypothetical drug that produced the same effects as heroin but did not lead todependency, some participants could see no reason not to allow its use forrecreational purposes.

Approaches to regulation

Protecting vulnerable people

Initially, this was seen as positive. Participants saw advantage in regulation designedto safeguard the interests of older people, children, people with mental healthneeds and other vulnerable members of society. On further examination, however,questions arose over how vulnerability would be defined, who would be involved indeveloping the definition and who would determine whether a particular individualshould be classed as vulnerable according to that definition. The young people sawregulation of this nature as a way of arming themselves against peer pressure totake illicit psychoactive substances. They suggested that being able to point to thelaw as a reason not to do so might be easier for some people than leaving it amatter of personal choice. To that extent, it is perhaps providing exactly thatprotection, seen as positive by the older participants.

Should it be the next of kin's decision or should it be a medical professionalwho says, her lungs are in that state or her liver or kidneys in that state,

because of the alcohol. So we feel it's in their best interests that they stop.Who makes that decision?

Preserving social order

This was seen as important and was viewed as the primary reason behind existinglegislation against the use of certain psychoactive substances. Recent changes tothe laws on the sale of alcohol were discussed in relation to the preservation ofsocial order, with mixed views on whether the changes would aggravate or alleviatebinge drinking and associated social problems. Again, the issue arose of who makesthe decisions and according to what criteria. Young people in particular felt thatmaintaining social order would have benefits for the individual too and would lead toa safer country with reduced crime and a healthier workforce.

Preserving public health

Considered in the abstract, regulation to preserve public health was seen as positive.Dependency on illicit psychoactive substances was seen as leading to illness andreliance on public money. The Government was seen as having some duty to regulate


Section III: Laying the ground

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in the interests of the wider public. The need for good scientific advice and researchwas stressed in relation to this issue. Referring to the changing state of knowledge onthe effects of tobacco and alcohol over the years, some participants said that publichealth had suffered because scientists have not been sufficiently involved in decisionmaking. Taking this argument further, they suggested too that this may be because ofthe tax income accumulated from the sale of licit recreational drugs such as alcoholand tobacco and that the voice of science may be heard less clearly when loss ofsubstantial income is the consequence of listening. Some saw a contradiction in thecurrent situation, with Government continuing to raise taxes on tobacco whilerestricting consumption. Presented with the hypothetical situation in which sciencediscovers hidden harms in coffee and tea, however, participants drew the line at theregulation of these substances.

It's difficult – you can't say, you can't have a cup of coffee 'til you're 16.

Participants from Derry commented on two initiatives in Northern Ireland that hadchanged the patterns of consumption of licit recreational drugs. One was the recentintroduction of a smoking ban in public places in the Republic of Ireland, which wasfelt to have encouraged people to cut down or stop smoking – and to have led toan increase in cross-border traffic as hardened addicts drive north to find anatmosphere in which to drink that is more conducive to their nicotine habit. Theother example was that of using pricing mechanisms to change choices at the bar.The cost of soft drinks had been reduced in some pubs to encourage theirconsumption instead of that of alcohol.

The smoking ban (in the Republic of Ireland) is very good because people don'tsmoke so much when they are not around people smoking.

There are people who go into bars and don't want to drink alcohol, but it'scheaper to buy an alcoholic drink than a soft drink. But some pubs have

reduced prices on soft drinks to encourage less alcohol drinking.

Making sure that drugs that are available are pure

This was discussed initially with reference to prescribed and over-the-counter drugsand it was taken as unarguable that this is a good thing. If purity is regulated, userscan make choices based on their individual need without worrying about side-effects that might arise from adulterated psyhoactive substances.

You want it to do exactly what it says on the tin.

In the context of illicit drugs, this argument tended to lose persuasive force and twopositions emerged, with participants split fairly evenly between them. Some feltthat providing testing kits for people intending to take illicit substances to ensuretheir purity indicates implicit approval of that behaviour. Making such kits


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commercially available, or free at clubs where young people might take drugs, wasfelt to send out messages that are contrary to the wider attempt to stamp out theuse of illicit psychoactive substances .

Others argued that protecting young people should take precedence over the legalstatus of the substances they choose to ingest. Those supporting this view felt thatpeople have always used and always will use psychoactive substances and that thelaw will not prevent this. They felt that society has a responsibility to protect eventhose who break the law, especially when, very often, these are young people.Providing testing kits was seen as a way of allowing individuals some greaterprotection and also as a possible disincentive to suppliers against the adulterationof drugs, so reducing the harm that can arise from impurities.

We were discussing the Leah Betts campaign – how much moreheartbreaking is it to see a young girl at the beginning of her life on a

life support machine. That won't stop people taking ecstasy – that's the sadthing – no matter what you tell people, they think, I'm smarter than that,

I know what I'm doing. That's what you need to deal with.

It sends a message that it's acceptable. That it's ok to go and sniff up some cocaine.

Preventing harm to drug users and others

Regulation for this purpose was seen within the context of prescribed and over-the-counter drugs referring to dosage information. For recreational drugs, the requiredinformation on tobacco packets about the dangers of smoking was seen as helpingpeople avoid harm, to both themselves and, where information is about passivesmoking, others. The tension between individual choice and harm to self and otherswas seen as hard, if not impossible, to resolve. Younger participants felt thatindividuals should have the right to take harmful substances if they choose, butrecognised the difficulties in drawing a firm line between harm to the individualconsumer and harm to those around them.

Some participants argued that regulation of this type should not be necessary,especially in the case of tobacco. They felt that manufacturers should be duty-boundto reduce the harmful effects of their product and if they were unable to do this,they should not be allowed to sell it. There was some disagreement with this, onthe basis that it would restrict individual choice to an unacceptable degree.

If it affects the rest of the family then maybe there's a need for it to beregulated, but if it's only affecting you, then that's personal choice.



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Raising taxes

Regulating substance use to raise taxes was seen as a way of deterring theconsumption of potentially 'anti-social' drugs and thus as having a protectivefunction. Reference to tobacco and alcohol was made in this context. There were,however, some questions raised about the use to which tax monies are put. Manyfelt that taxes raised in this way should be channelled into education andinformation campaigns about the dangers of some substances. There was also adegree of cynicism about the regulation of tobacco through taxes, as noted above.

Some argued that Government is the only beneficiary of tax-raising regulation. Theysaw it as exploiting addiction, because, no matter how high taxes are raised, peoplewho are addicted to nicotine will pay what they have to for their drug.

The ADDISS group looked further forward and considered a possible time whencannabis or cocaine might be legal. Both of these drugs were seen to have positivebenefits for some people with ADHD and, in this case, it was felt the substancesshould not be taxed.

Preserving economic productivity

There was very limited discussion of this reason for regulation. It was seen as adifficult question, about which participants had little knowledge. If regulation of thistype is used in the interests of people who wish to overcome dependency andreturn to work, it was seen as positive; otherwise many saw it as potentiallycoercive.

For religious or cultural reasons

This was seen as a matter for the particular groups in question and one in whichwider society should not have a voice. Other groups were expected to respectdecisions made for these reasons.

Restricting use to particular groups of people

Regulation to restrict the use of some psychoactive substances to particular groupsof people was seen as a way of looking after the interests of more vulnerablemembers of the population, for example, young people, who are more likely eitherto be harmed by substances or not to understand the implications of using them.The young people in the discussion saw this type of regulation in a slightly differentway, arguing that there could be social benefits to targeting some substances atsome groups of people. They argued that there would be a social benefit in alteringthe testosterone levels in aggressive males.


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Initial understanding of the area

This section provides an outline of participants' initial understanding of and attitudesto some of the key issues and players involved in this topic (summarised in Tables 3to 7).

Science

Table 3: Summary of participants' perspective on science

We have the capabilities but we don't always put them to the right use.

Science is what brought this country to where we are today – it's why we areas far as we are and not a third-world country.

Science is not enough – that's inflexible. You need to take into accountpersonality and lifestyle.

How far is science about making somebody richer and how far is it abouthelping humanity and curing illness?

After a while you don't know what to believe.

Knowledge Experience

Limited Personal experience through own and children's education

Immediate top-of-mind references to cloning, nanotechnology, progress, potential, benefits, Personal research (students and ADDISS)specific branches of science, intellectual difficulty and frightening possibilities Media coverage

Strong bias towards experimental science in Lobbying and support groupsmental health area in ADDISS group

Attitudes Concerns

Mostly positive and some sophisticated; but Unintended consequences arising from over-there is a call for balance, introduced primarily zealous approach – though also seen by many by evaluation of the social and ethical context as intrinsicwithin which science takes place

How to achieve an appropriate balance of The least knowledgeable tend to be least benefit and riskpositive

Poor use of good science, seen as driven in part by profit



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Science was thought, on the whole, to bring great benefits to society. Most of thetop-of-mind references were drawn from media coverage of recent developmentssuch as cloning and nanotechnology, and participants demonstrated awareness ofsome of the issues that characterise discussion in these areas. Those with morelimited knowledge were more likely to use words such as 'frightening' and 'pain'.

The high profile given by the media to BSE, the possible dangers of radiation frommobile phones, MMR and the legacy of thalidomide acted as counters to thegenerally positive attitude. They highlighted to most people the need for aprecautionary approach, whereby the negative side-effects and potential long-termdamage of new developments are researched in full before the release of newpsychoactive substances onto the market. The difficulties of this are acknowledged,for example, people might be deprived of a potentially beneficial psychoactivesubstance while research and trials are ongoing. It may be that greater knowledgeof the process by which psychoactive substances are brought to market and morenuance in the media coverage of these issues would allow people to develop theirunderstanding of the balance between benefit and risk in this area.

Given the overall theme of the project, it is perhaps not surprising that thedifferences between science, medicine (e.g. GPs, psychologists) and thepharmaceutical industry were blurred. Often, concerns raised about science relatedmore directly to prescribing practices and the use of psychoactive substances,rather than the science behind their development.

Adult participants' recollection of science at school tended to be limited – and not,on the whole, very positive. This was in marked contrast to the views of the youngpeople, since many were taking higher-level sciences at school. The range of debateswithin science to which the young people referred was considerably wider than thatof adults and included the relation of science to religion, with specific mention of thecreationism debate and the use of scientific knowledge for 'social engineering' or, asone young person expressed it, 'messing with the soul'. This resonates with theconcerns mentioned above, about the use of some substances being 'unnatural'.

Participants using or caring for people using psychoactive substances for mental healthpurposes were noticeably more informed, less awed by and more sceptical of science.Their knowledge of the breadth of scientific opinion on the benefits and disadvantagesof many psychoactive substances and the search for accessible and reliable informationhas left them with considerable understanding of specific substances and the debatessurrounding their use. It has led also to some practical confusion about what might bethe best treatment for them or those they care for. Some expressed resentment atbeing used as 'guinea pigs' for psychoactive substances whose side-effects they seeas insufficiently well researched. Many were very angry about the misinformation ofsome media coverage of drugs, methylphenidate e.g. Ritalin, in particular.

Sensationalism makes for a good story – whether or not the facts are right.


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The context of science

References to the wider context within which science takes place were frequent.The gap between levels of knowledge among the broad population and advancesin science, together with very little sense that scientists are interested in bridgingthat gap, left many participants feeling that the ability of society to influence thedirection and speed of developments is limited. This was particularly clear indiscussions around vitamins and herbal remedies, about which there has beenconsiderable recent debate in the media.

Some members of the ADDISS group had a perspective on science resonant withdebates within the philosophy of science. They felt that science at any particulartime is informed by a prevailing view linked to organisational policies and budgets,rather than deriving simply from the interests of pure research, or the needs ofsociety. It is not clear whether this was informed by experience, or by reading thephilosophy of science.

The pharmaceutical industry

Table 4: Summary of participants' perspective on the pharmaceutical industry

In the capitalist world you have different industries and some, like the drugsindustry, are very, very controlled, to the extent that they're a monopoly.

They don't just let anybody come in and compete with them. All these many,many companies that we know, if you get down to the bottom of it, youfind that only very few people own all of them and they're subsidiaries.

They control them and you can't do anything.


Limited No first-hand knowledge – experience is limited to word of mouth and media coverage

Some knowledge of research and development (profits ploughed back into research)

Attitudes Concerns

Scepticism, mainly traceable to the perception Lack of access to drugs due to costthat research is driven by profit rather than social/medical needs Government subsidies for research and

development that profits companies, rather The industry provides as little information on than individuals or societyside-effects as possible, which is against users' interests Monopolistic – ownership is concentrated in

hands of a very few large companies The industry is able to control research and the publication of research results



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I've got a friend who works as a salesman for a drugs company and he'snever stopping taking doctors to the Caribbean and the south of France –

now how is that right?

Participants' views of the pharmaceutical industry were mixed. All recognised thatthe industry has, over the years, developed cures and treatments for ailments thatwould previously have been fatal. But the pure profit motive, to the exclusion ofwider social issues, was seen as suspect and, in general, was felt to drive theindustry.

Concerns focus primarily on information. Many participants questioned whetherpublished research results are as honest about the harmful side-effects of drugsas they are about the positive benefits. What was seen as limited competitionbetween a few very large companies was felt to have concentrated power in thehands of industry to the extent that information that might inform choice can bewithheld from the public.

Prescribed psychoactive substances

Table 5: Summary of participants' perspective on prescribed psychoactive

substances

They need to look at other ways of treating illnesses rather than justprescription drugs.


Media – including newspaper reports, Personal use (for example, methylphenidate TV drama (mention of methylphenidate e.g. Ritalin/child using Ritalin, medicinal opiates)e.g. Ritalin on Desperate Housewives)

Word of mouth

Personal research

Attitudes Concerns

Broadly positive 'Postcode lottery'

Minority suggested over-reliance on prescribed Poor/over-prescribing e.g. antibiotics, medications and the need to seek more behaviour modifiers'natural' solutions through diet, exercise or herbal preparations Insufficient/inadequate testing prior to release

of medicationGPs have to consider the nation's productivity when prescribing – keep people sufficiently healthy to work


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We are living in a consumer society. To compete with each other we end upgetting in more and more debt. Stress builds as a result of this. Unless you

can find a way of easing that stress, it's very easy to fall for drugs and beforelong you are addicted.

Two concerns were raised about prescribed drugs. The first questioned the extentto which society as a whole had come to rely on them and, as a consequence,ceased to invest in measures such as diet and exercise as a way of dealing withhealth problems. Some participants felt that GPs could be over-eager to prescriberather than spend more time with a patient but placed this within the wider contextof financial pressures facing the NHS.

The second concern was over the 'postcode lottery'. It was seen as unfair thataccess to specific medications might be dependent on where a person lived.

Legal recreational psychoactive substances

Table 6: Summary of participants' perspective on legal recreational

psychoactive substances


Caffeine, alcohol, nicotine, vitamins, Many ex-smokers – now significant majority herbal preparations all seen as non-smokerspsychoactive substances

Majority consume alcohol

Many take vitamins or herbal supplements

Peer pressure seen as changing behaviour

Majority of young people anti-smoking and non-drinkers

Attitudes Concerns

UK policy on smoking – some saw it as Binge drinking, drink drivingcynical, others as positive

Young drinkersRecognition of problems associated with legal recreational psychoactive substances Social costs of alcohol abuse

Awareness of changing social attitudes

Parenting felt to influence behaviour



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The problem we have is that we think alcohol is socially acceptable. But in40 years' time that will have changed, same as smoking has changed. If youthink back to when we were kids, everyone smoked, everyone, and people

smoked anywhere. But now it is unacceptable and you are a social outcast ifyou're trying to smoke somewhere and you're made to feel it. But at the

moment, alcohol is fairly acceptable, in moderation.

People who are drinking a good bottle of Scotch don't usually go out andmug someone to get it.

Participants tended to place the use of licit recreational psychoactive substanceswithin a social context – which is unsurprising, given that the great majority usedthese substances. The social cost of alcohol abuse was recognised, as were theharmful effects of tobacco use. However, as noted above, these were seen by amajority as being of a different order to the social costs of illicit psychoactivesubstance use.

Illicit psychoactive substances

Table 7: Summary of participants' perspective on illicit psychoactive

substances

These drugs should be free and that way it would be people's choice. It'sbecause they're unavailable that 99% of the people want to try them.


Media No personal fears (e.g. local drug use)

Glasgow research on heroin Awareness of drug use in local schools (London)

Cannabis use by MS sufferers

Attitudes Concerns

Majority adopted hard line (more likely to Illegality is the basic issuebe men)

Illicit psychoactive substances seen as morally Some more liberal – called for need to wrongunderstand reasons for use

Social cost, crime in particular


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If kids are seeing people that are staggering in the road, throwing up, dirty,filthy, being scorned by society or doing anything in the road for money, thenit seems a completely different thing to the young successful business manwho sneaks the odd line of cocaine off a toilet top when no one's looking –

it doesn't have the glamour.

Many people with undiagnosed mental health problems and who aregenetically predisposed turn to psychoactive substances as a way of

controlling their symptoms.

I think society has become too soft.

Attitudes towards illicit psychoactive substances were, with few exceptions, hardline, with men tending to be more negative in their attitudes towards users thanwomen. Media coverage of 'the war on drugs' informs most views. Twoparticipants in the general public groups referred to personal experience of illicitpsychoactive substances. One participant argued openly in favour of legalisation.His views were respected, but not influential.

While it was recognised that dependency and the ability to self-regulate use maypresent problems with all psychoactive substances, the general view was thatthe initial use of illicit substances is a choice not driven by need, as it is withprescription psychoactive substances, but by some kind of individual failing or,among younger users, by peer pressure. Debates were therefore largely framedwithin a moral and legal context, with use seen primarily as straightforwardly wrong.Women were more likely to temper their condemnation with the appeal that theunderlying reasons for use of these drugs are sought out and addressed. Onegroup included participants who lived in areas where illicit substance users aremore visible and their views were informed by this presence. Again, the attitudesbetween men and women differed. One woman worked on a voluntary basis withdrug users and appeared to be saddened, rather than outraged, by personalfamiliarity with users.

This attitude means that, for many participants, a harm-reduction approach, focusedon encouraging safe use and involving, for example, needle exchanges or testingkits to measure purity, was seen as 'sending the wrong messages'. While it wasacknowledged that attitudes towards illicit substances change, with the recentreclassification of cannabis from Class A to Class C cited as an example, the 'harddrugs' such as heroin, crack and cocaine were placed within a different context.It is interesting to speculate whether the 'natural'/'unnatural' distinction mentionedearlier plays any role in this or whether it is exclusively due to awareness of therecent relaxation in laws governing possession and its lower classification.



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The only participants to take a different view were those using illicit substances andsome from the ADDISS group. They saw motives other than hedonism as behindthe use of illicit psychoactive substances, principally mental health problems.

Attitudes of illicit psychoactive substances users

The participants using illicit substances, including heroin, ecstasy, amphetamine,ketamine and cannabis, were as knowledgeable about their drugs as participantsusing or caring for users of behaviour modification and mental health drugs wereabout theirs. Like the latter, the illicit substance users have researched the scienceof the psychoactive substances they use and keep up to date with developments.This researcher's experience of previous work involving illicit substance usershighlights the difference that individual situation can have on the course and natureof use; these users were informed, articulate and engaged in the debate over theiruse, rather than crushed by it.

Participants using illicit psychoactive substances were extremely critical oflegislation in this area and of the way illicit drug use and users are portrayed bythe media. The media were seen as misrepresenting the reasons for use, thedangers and nature of the substances themselves, their effects on users and theconsequences of use for wider society. Like those in the ADDISS group, theseparticipants were highly critical of the media's 'hysterical' approach to the coverageof drugs, licit and illicit. They felt that the complexities around use are submergedunder a blanket moral condemnation, which demonises users and leads toignorance of the medicinal benefits of currently illegal psychoactive substances .They argued too that the media representation of illicit psychoactive substanceusers as worthless, weak, out of control and irresponsible people highly likelyto mug passers-by or burgle their houses is internalised by users themselves,exacerbating mental health problems that may have led to use in the first place.

The illicit psychoactive substance users also argued that the social and physicalharms associated with the use of these drugs is a consequence of the context ofuse, rather than of the use itself. Changing that context would, they said, changethe consequences. Greatly reducing, if not completely eliminating, black markettrade in illicit psychoactive substances by legalising supply through licensedoutlets was seen as the most effective ways of addressing these harms.Providing accurate information about the variable effects of the substances inquestion and what might influence these effects, initiating a balanced debate onthe benefits and disadvantages of use, and normalising social use weresuggested as healthy alternative approaches to the current situation.


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Attitudes of young people

The young people involved in this research produced, along with illicit substanceusers, the most sophisticated arguments on this topic. Their views ranged fromthe libertarian, proposing that adults should be free to use whichever substancesthey choose, with the proviso that this did not cause harm to others, to totalcondemnation of the use of any recreational psychoactive substances, includingalcohol and tobacco. Condemnation appeared to be based on perplexity as to whypeople would choose to use these drugs, rather than the more straightforwardmoral disapproval voiced by older participants. Their attitudes aligned most closelywith those of the older female participants.



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This consultation demonstrated the capacity of the public to engage with a complextopic. There are difficulties intrinsic to assessing the plausibility of future scenariosin any area and judgements are necessarily based on existing knowledge. Thefutures envisaged in this project involved psychoactive substances whose possiblesocial effects are unknown. Participants were asked to express preferences anddevelop principles that might inform the management of these substances in thebest interests of society. Their views were informed by personal experience, mediacoverage, briefing materials used in the consultation, and conversation with otherparticipants.

The importance of personal experience in this area was highlighted by thedifference in attitude between participants recruited as 'members of the public'and those from specific interest groups – in this case people with or caring forpeople with ADHD and illicit substance users. These participants had considerablymore knowledge of the science behind the project. Their attitudes towards illicitsubstance use was also very different. They tended to classify it as self-medicationand to see use of illicit psychoactive substances as a response to mental healthneeds, rather than being indicative of a personal moral failing or hedonistictendencies.

The difference made by personal experience was evident too in the youngerparticipants. As students of science, they were accustomed to discussing theissues science raises, both as a practice and in relation to wider society. Forexample, they alone raised the question of conflict between science and religion.They also showed more faith in science and government than older participants.The latter, who had lived through or been personally affected by the thalidomidedisaster, food scares or medical errors, tended to be more sceptical and theirreactions to future science combined curiosity, anticipation and wariness.

The principal standard for future policy development to emerge from the project isthat of openness. The enthusiasm shown by participants for the project as a wholedemonstrates a desire for both knowledge and a role in decision making in this area.Deliberative consultation that engages the public in open discussion of theimplications, for society as a whole, of developments in science – and there canbe few developments, if any, that have no social implications – can contribute toimproved decision making and better policy.

Conclusions

The preference for individual choice expressed by the majority of participants wasbased on the concern that ceding choice in this area could lead to psychoactivesubstances being used coercively. While it was acknowledged that this preferencebrought dangers with it, a vibrant, creative and diverse society was seen as moredesirable than a society based on the principle of community safety. The use ofpsychoactive substances to regulate behaviour regarded as 'unusual' or 'abnormal'was seen as leading potentially to a 'normalised' society from which excitementhad been eliminated.

Individual choice was preferred, too, because of concern over the power ofgovernment to intervene in people's lives. This concern highlights the need for opendiscussion, to assuage misplaced fears or, possibly, to alert the public to fears thatare not misplaced. The project was looking 20 years into the future. One of themessages sent by participants is that it may be dangerous to assume that thefuture management of the use of psychoactive substances will be benevolent.Questions over who might be classed as 'vulnerable' and who might be doing theclassifying, worry over the potential for the coercive use of psychoactive substancesand over the tendency for profit, rather than need, to drive research, all feed intothis message.

The project began by looking at four classes of psychoactive substance: mentalhealth drugs, mood-altering drugs, pleasure drugs and cognition enhancers.However, many substances fall into more than one of these classes andparticipants' discussion made it clear that the reason for use and the context behindit were more relevant to them than the specific class of substance. Four broadgroups of use were identified: medical use, social use, illegitimate use and lifestyleuse. Potential new substances used for reasons already established were mosteasily accepted. Voluntary use by adults of cognition enhancers was lesstroublesome than immunisation of children against the potential future expressionof genetically identified predispositions. A distinction between 'natural' and'unnatural' pharmaceutical interventions was not evident in the case of medical use,where alleviating suffering was of primary concern. It was evident in discussions oflifestyle use; herbal preparations were seen as natural, whereas substancesproduced in a laboratory were not.

The focus on use, rather than class of substance, suggests that the public cuts up the world and conceptualises it differently from those who work in this area. This in itself is a valuable lesson for any future public engagement on this and othertopics. Flexibility and a willingness to accept an agenda different from that initiallyestablished are important to open discussion.


Conclusion

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All publications are available in hard copy and/or can be downloaded from theForesight website except those marked *** which are available only from thewebsite (www.foresight.gov.uk).

1. Executive summary and project overview

2. State-of-science reviews ***I. Cognition EnhancersII. Drug Testing III. Economics of Addiction and DrugsIV. Ethical Aspects of Developments in Neuroscience and AddictionV. Experimental Psychology and Research into Brain Science and DrugsVI. Problem Gambling and other Behavioural AddictionsVII. GenomicsVIII. History and the Future of Psychoactive SubstancesIX. Life Histories and Narratives of AddictionX. NeuroimagingXI. Neuroscience of Drugs and AddictionXII. Sociology and Substance UseXIII. Social Policy and Psychoactive SubstancesXIV. Psychological Treatment of Substance Abuse and DependenceXV. Pharmacology and Treatments

3. State-of-science reviews (2 page summaries)

4. Ethical issues and addiction overview ***

5. Horizon scan

6. The scenarios

7. Public perspective

8. Perspective of the pharmaceutical industry

9. Modelling drug use

List of publications: Drugs Futures 2025?

Printed in UK on recycled paper with a minimum HMSO score of 75First published July 2005. Department of Trade and Industry. www.dti.gov.uk/

© Crown Copyright. DTI/Pub 7919/3k/07/05/NP. URN 05/1185

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